ABSTRACT
BACKGROUND AND AIM: Renal function is noticeably altered in both hypothyroidism and hyperthyroidism. However, clinical studies on thyroid dysfunction and its association with renal function are scarce. The purpose of this study was to evaluate changes in biochemical parameters of renal function in subjects with thyroid dysfunction and to correlate these values with the patient's thyroid profile. The effect of changes in thyroid function during therapy on renal function was also investigated. METHODS: A prospective cohort study included 41 patients with untreated primary hypothyroidism and 16 patients with untreated hyperthyroidism. Thyroid-stimulating hormone (TSH), free thyroxine, and free triiodothyronine were assessed using immunoassay. The estimated glomerular filtration rate was calculated by the Modification of Diet in Renal Disease formula. Renal function tests were assessed in all patients at each of the two-time points: during thyroid dysfunction (hypo- or hyperthyroidism) and after attaining euthyroidism. RESULTS: Our study demonstrated a statistically significant reduction in the average serum creatinine level in the hypothyroid patients after treatment compared to before treatment whereas the mean estimated glomerular filtration rate (eGFR) significantly improved after treatment compared to before treatment. Moreover, the average serum creatinine level in the hyperthyroid patients was significantly lower before treatment compared to after treatment, whereas the mean eGFR significantly dropped after treatment. TSH had a significant positive correlation with serum creatinine and a significant negative correlation with eGFR in all patients with thyroid dysfunction. CONCLUSIONS: Thyroid dysfunction is associated with deranged kidney function. It is crucial for the clinician to be aware of the link between thyroid disorders and aberrant renal function in order to consider a thyroid function test when treating a patient whose biochemical markers of renal function are only mildly elevated. There is a need for monitoring creatinine in patients with thyroid dysfunction.
ABSTRACT
INTRODUCTION: The appetite-modulating hormone ghrelin may have a role in the etiology of anorexia which is a serious concern in patients with primary biliary cirrhosis (PBC). This study aims to assess the difference in ghrelin level between cases of PBC and healthy controls matched for age and gender, and to evaluate the level of ghrelin in relation to clinical and laboratory findings among cases. METHODS: Twenty patients with primary biliary cirrhosis and 30 healthy controls matched by gender and age were recruited. The severity of liver disease was determined using the Child-Pugh grading system. Clinical comorbidities such as a history of ascites, gastrointestinal bleeding, and encephalopathy were evaluated. A commercial enzyme-linked immunosorbent assay was used to measure total ghrelin. Results: PBC cases had a significantly higher average level of ghrelin (2305.3 ± 639.4) pg/mL compared to controls (682 ± 197.3) pg/mL. Furthermore, the minimum reported level in cases was 1258 pg/mL compared to 326 pg/mL in controls, while the maximum level nearly tripled the control's maximum level. In PBC patients, plasma levels of total ghrelin showed a weak positive correlation with age, an inverse correlation with body mass index, and were not associated with gender. The level was significantly higher than those in the controls. Ghrelin was associated with the severity of cirrhosis. Levels of serum ghrelin were higher in patients with associated comorbidities such as a history of ascites, gastrointestinal bleeding, and encephalopathy. CONCLUSIONS: Our study demonstrated elevated serum ghrelin levels in patients with primary biliary cirrhosis. Serum ghrelin was associated with the degree of severity and the presence of related comorbidities. Patients with primary biliary cirrhosis remain anorexic and catabolic despite elevated ghrelin levels, suggesting tissue resistance to this anabolic peptide which could be crucial to understanding anorexia and cachexia in primary biliary cirrhosis.
ABSTRACT
Aim of the study: Evaluation of thyroid function and thyroid autoimmunity in patients with non-alcoholic fatty liver disease (NAFLD). Material and methods: A case control study. Fifty patients with NAFLD and 50 control subjects matched by gender and age were recruited. Serum thyroid stimulating hormone (TSH) and free thyroxine (FT4) were measured to assess thyroid function. Thyroid autoimmune disease was evaluated by measuring thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibodies (TgAb). The FIB-4 score and the APRI score were calculated to assess the degree of fibrosis. The association between thyroid parameters and NAFLD was explored. Results: About one quarter of patients with NAFLD had hypothyroidism compared to 10% of the control group whilst 6% of NAFLD patients had hyperthyroidism compared to 2% of the controls. NAFLD cases showed substantially higher TSH and lower FT4 compared to controls; meanwhile, levels of fibrosis indices (FIB-4 and APRI score) were significantly higher among hypothyroid patients in both cases and controls. TSH had a positive strong correlation with FIB-4 and APRI score, whereas FT4 had a negative significant correlation with both fibrosis indicators, and this clinical relationship was similar in NAFLD cases and controls. Conclusions: Hypothyroidism is more prevalent among patients with NAFLD compared to controls and high levels of TSH with low FT4 might be a risk factor for NAFLD and may impact the development of liver fibrosis. The role of thyroid autoimmunity in NAFLD needs further assessment. NAFLD patients should be monitored by yearly TSH and FT4 testing.
